Effectiveness of physiotherapy interventions on disease-specific and generic outcomes for individuals with cardiovascular diseases in India–a systematic review and Meta-analysis

Abstract

Background: The incidence of cardiovascular diseases (CVDs) is rising in India and there is a need for a systematic review to corroborate the effects of physiotherapy interventions and their cultural adaptations on CVDs in India. Objectives: To summarize the level of evidence for the effects of physiotherapy interventions on disease-specific and generic outcome measures in individuals with CVDs and assess cultural adaptations of these interventions in India (PROSPERO registration: CRD42019128342). Methods: Eight databases were searched from inception to March 2019. Two reviewers extracted data and assessed risk of bias of the eligible studies (controlled/randomized clinical trials [RCTs]) using the Cochrane RoB2 tool. A meta-analysis was conducted using a fixed-effects model. Overall evidence was synthesized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Results: Of 1349 citations retrieved, only 4 RCTs including 165 individuals (130 men) with CVDs (post-myocardial infarction, left ventricular failure, and stable/congestive heart failure) met the inclusion criteria. The results demonstrated a significant improvement in 6-minute walk distance, blood pressure, anxiety and quality of life following physiotherapy interventions in individuals with CVDs. However, there was a high risk of bias for all outcomes. There were critical weaknesses in all domains of GRADE criteria for all outcomes which resulted in a very low evidence. The cultural adaptations of interventions were inadequately reported. Conclusions: Owing to a small number of studies with a high risk of bias and heterogeneous results, methodologically-robust RCTs are warranted for finding a more conclusive evidence on physiotherapy interventions for CVDs in India.